The use of prebiotics during the first year of life for atopy prevention and treatment.

de Moura PN, Rosário Filho NA - Immun Inflamm Dis (2013)

Bottom Line:
The incidence of allergic diseases has increased in recent decades.The treatment group size ranged from 134 to 259 children, and the studies compared prebiotic to placebo treatment in each group.Although there was a trend for reduced allergic symptoms following the administration of prebiotics, there was not sufficient evidence to establish that such treatment is effective for the prevention of allergies in children.

ABSTRACTThe incidence of allergic diseases has increased in recent decades. Therefore, the aim of this systematic review was to assess the efficacy of prebiotics for the prevention and treatment of allergic manifestations in children. We sought to conduct a systematic review of the effectiveness of prebiotics in the prevention and treatment of allergic diseases in children. We searched the MEDLINE, EMBASE, Cochrane Library, LILACS, SciELO, IBECS, Web of Science and Clinical Trials databases as well as Google Scholar and the references of the articles identified. Randomised clinical trials, in which one of the treatments was performed with prebiotics and the control group was treated with placebo, were included in the review. The data selection were performed by two reviewers, and the study quality was evaluated according to the Consolidated Standards of Reporting Trials (CONSORT) items, according to the recommendations for improving the quality of reports of randomised clinical trials. The selected studies showed heterogeneity with regard to the participants, albeit with similar outcomes. The treatment group size ranged from 134 to 259 children, and the studies compared prebiotic to placebo treatment in each group. In general, these articles showed a trend toward less allergic reactions in the groups receiving active therapy with prebiotics. Although there was a trend for reduced allergic symptoms following the administration of prebiotics, there was not sufficient evidence to establish that such treatment is effective for the prevention of allergies in children.

fig02: Forest plot depicting a meta-analysis of the effect of prebiotics on allergic manifestations.

Mentions:
The vertical line shows where the odds ratios equal to 1 would be represented, which would indicate the absence of an association between treatment with prebiotics and the occurrence of allergic manifestations. Thus, the odds ratios represented to the left of this vertical line show that allergic manifestations are more likely to occur among controls, and the odds ratios shown to the right of this line demonstrate that allergic manifestations are more likely to occur among those treated with prebiotics. The 95% confidence interval will have a value of 1 if the horizontal line crosses the vertical line, which shows that the effect of using prebiotics on the occurrence of allergic manifestations in that particular study is not statistically significant (the interpretation is similar to that usually performed when the value of P is greater than 5%, although it should be noted that this concept of “statistical significance” is always affected by the sample size). Figure 2 shows that the confidence intervals associated with studies 4 and 5 have a value of 1, indicating that their respective odds ratios (OR) are “not statistically significant.” Conversely, studies 4 and 5 noticeably have smaller sample sizes than do the others, suggesting that this “statistical significance” may have not been reached because of the reduced number of subjects in the studies.

fig02: Forest plot depicting a meta-analysis of the effect of prebiotics on allergic manifestations.

Mentions:
The vertical line shows where the odds ratios equal to 1 would be represented, which would indicate the absence of an association between treatment with prebiotics and the occurrence of allergic manifestations. Thus, the odds ratios represented to the left of this vertical line show that allergic manifestations are more likely to occur among controls, and the odds ratios shown to the right of this line demonstrate that allergic manifestations are more likely to occur among those treated with prebiotics. The 95% confidence interval will have a value of 1 if the horizontal line crosses the vertical line, which shows that the effect of using prebiotics on the occurrence of allergic manifestations in that particular study is not statistically significant (the interpretation is similar to that usually performed when the value of P is greater than 5%, although it should be noted that this concept of “statistical significance” is always affected by the sample size). Figure 2 shows that the confidence intervals associated with studies 4 and 5 have a value of 1, indicating that their respective odds ratios (OR) are “not statistically significant.” Conversely, studies 4 and 5 noticeably have smaller sample sizes than do the others, suggesting that this “statistical significance” may have not been reached because of the reduced number of subjects in the studies.

Bottom Line:
The incidence of allergic diseases has increased in recent decades.The treatment group size ranged from 134 to 259 children, and the studies compared prebiotic to placebo treatment in each group.Although there was a trend for reduced allergic symptoms following the administration of prebiotics, there was not sufficient evidence to establish that such treatment is effective for the prevention of allergies in children.

ABSTRACTThe incidence of allergic diseases has increased in recent decades. Therefore, the aim of this systematic review was to assess the efficacy of prebiotics for the prevention and treatment of allergic manifestations in children. We sought to conduct a systematic review of the effectiveness of prebiotics in the prevention and treatment of allergic diseases in children. We searched the MEDLINE, EMBASE, Cochrane Library, LILACS, SciELO, IBECS, Web of Science and Clinical Trials databases as well as Google Scholar and the references of the articles identified. Randomised clinical trials, in which one of the treatments was performed with prebiotics and the control group was treated with placebo, were included in the review. The data selection were performed by two reviewers, and the study quality was evaluated according to the Consolidated Standards of Reporting Trials (CONSORT) items, according to the recommendations for improving the quality of reports of randomised clinical trials. The selected studies showed heterogeneity with regard to the participants, albeit with similar outcomes. The treatment group size ranged from 134 to 259 children, and the studies compared prebiotic to placebo treatment in each group. In general, these articles showed a trend toward less allergic reactions in the groups receiving active therapy with prebiotics. Although there was a trend for reduced allergic symptoms following the administration of prebiotics, there was not sufficient evidence to establish that such treatment is effective for the prevention of allergies in children.